A Physician Assistant's Ecuadorean Experience

Above: Jessica Seymour with a group of young girls of the Tsachilla community. The children enjoyed playing with the UK Shoulder to Should Ecuador team and loved getting their pictures taken.

Trial by Fire

It was a hot, humid South American day. Every bump, crevice, and pothole in the Ecuadorean road could be felt through the bus's shocks. It was almost noon and Jessica Seymour, a 2nd year student in the Physician's Assistant Studies program in the University of Kentucky (UK) College of Health Sciences, along with the rest of the UK Shoulder to Shoulder Ecuador team, had already been on the road for five hours.

They were traveling from their first clinical stop in the northern city of Cayambe and on the road to Santo Domingo, the location of their main clinical site. The route between the two is a beautiful but long, shoulder-less road over steep ravines winding through the Andes Mountains.

Before long, the buses came to a standstill, with the traffic backed up for over a quarter-mile. A few minutes later the group learned a tanker truck and bus collided, sending the bus down to the bottom of the ravine – they needed supplies and assistance. The Shoulder to Shoulder Ecuador team, comprised of students, faculty and staff from UK's colleges of medicine, nursing, public health, health sciences, dentistry, design, education and arts and sciences immediately left to join the rescue effort.

Seymour's clinical rotations in the Physician Assistant (PA) program had not yet begun and though she interned at a hospital in her hometown of Maryville, Tennessee, this trip to Ecuador was Seymour's first real medical experience.

I ran down there and got to the top of the hill," said Seymour. "First I thought, 'This is so steep. How am I going to get down there?' After taking a second to evaluate the situation around her, Seymour looked to one of the medical residents and said, "Ok, tell me what I can do."

Seymour and several other team members began assisting victims up the ravine to a line of waiting ambulances.

"We just got on either side of people who could walk. Well, you don't walk up the hill – we helped them crawl up the hill. One time I was just behind somebody, pushing their bottom, pushing them up."

Soon more medical personnel arrived and brought backboards for the injured, but supplies were still limited.

"I collected people's shoes, because there were no neck braces," Seymour said. "One of the residents asked me to collect all the shoes I could find. That was kind of traumatic – grabbing people's shoes. I was pulling them off people's feet that were on the backboard – they used them to brace them. We brought down all our Shoulder to Shoulder t-shirts and ripped them up to tie on the shoes or tie them on the backboard."

After roughly an hour of scrambling up and down the ravine, the rescuers finished evacuating the last of the crash victims. The gravity of the situation hit her after coming up from the ravine the last time – she shed a few tears, mainly in disbelief of what happened.

"I think with any experience, even if I wasn't in Ecuador, I think my first time in the ER, if I had this big crash and victims come in, I think I would have had similar reactions," she said. "I think it was just because it was my first time."

"Finally when we were all done, they threw down some rope so we could pull ourselves up," said Seymour. "All the local people were thanking us. They were all very gracious. That's when it hit me, when I went back up the final time, when I knew we were done, I said, 'oh my gosh, that was crazy.'"

Seymour didn't think it was much, but she knew she did what was necessary. "Even though I'll never see those people again, I know that they're in a better situation now than they would have been in we hadn't got down there so soon."

Working in the Clinics

After waiting for the traffic to clear that Monday afternoon, the team continued on Santo Domingo to conduct medical clinics. If being thrown into the middle of a major rescue effort wasn't enough, Seymour jumped head first into her clinical work and began evaluating and treating patients.

"We were going into these places at 8 or 9 a.m. and be there all day long," said Seymour. "I started with the doctor, but then we started seeing so many people that there'd be two or three doctors, me or any type of physician in one room seeing people. They all come in at one time and have all their forms with their vitals and histories and we did a couple different checks on them. So I have all this information in front of me, five different people in front of me at one time, so I just start with one, go through it and move on to the next. I saw them all by myself and after awhile you start to see the same things, so I knew what to do. I got help if I need to, but I'd really be sitting there until it was time to go. There at the end we'd had to turn some away because we didn't have time. I saw patients all day long – it was awesome. The time went by fast – I thought wow, I'm really doing something."

"In the didactic year, we had a class about how to do physicals. You have to learn things from a book, and that's great, but I was able to see how you do it in practical terms: what you listen to, what you don't, what you ask more about. I felt comfortable doing physical exams."

A Collaborative Educational Experience

The UK Shoulder to Shoulder Ecuador medical team consisted of a couple nurse practitioner students, two med school students, a handful of 1st-, 2nd-, 3rd-, and 4th-year residents, a pediatrician, a couple physical therapists and Seymour, the only PA. Seymour enjoyed working in the interdisciplinary setting. "It was nice to see different people, work with different people and see what levels they were on. It all worked together so well."

The trip to Ecuador was a great way to volunteer and help people in need, but it also proved to be a great learning experience. As a PA, Seymour worked with and learned from the physicians in the clinic with her.

One exam in particular stands out to Seymour:

"The kids were so fun to be with. It wasn't hard to interact with them – they were all really good. But you have to work with the parent. And they have a lot of different things – this was the first time I got to really listen to their heart sounds, which are different from adults. So the first time listening to some of the kid's hearts on my own, I said 'There's an extra sound in there.' I think that's what they're supposed to have, but I'm not sure. So I'd ask Dr. Young and he'd come listen. 'Yeah, it's normal.' So I learned and it's now something I won't forget."

"I was listening to his lungs and it just didn't sound right, I heard some crackles. The mom complained that he'd had bronchitis for two years. I thought, 'poor kid,' because he was only four. So I listened to his lungs and it didn't sound right and he just seemed tired – you know, not the normal happy kid. So I pulled the doctor, 'come listen to this.' He said, 'Yeah, you're exactly right. There are crackles in that left lung. I said, 'Oh, he's got pneumonia.'

"Oh my gosh, I really did something that was very beneficial for this little boy. If he didn't get health care anywhere else, who knows what would have happened? That kind of hit me, that I can do this and I want to do this and I have the potential to really learn a lot and help a lot of people. That was my shining moment. It was really cool."

By the end of their four days doing clinical work, the team had treated over 1,000 patients.

"I feel reassured about my ability to diagnose, to make correct decisions – I just feel more comfortable interacting with patients," said Seymour. "And I guess trusting myself and what I'm capable of doing. I guess I just feel more reaffirmed that this is what I want to do."

Exploring the Medical Field

Seymour explained the best way to explore one's interest in a medical profession is to jump in and see it for oneself.

"Get out there and actually see it and experience it – shadow somebody. A lot of people ask me about the trip and it's kind of hard to just tell somebody what you're doing without them actually experiencing it for themselves. If people are interested in the PA program, I highly encourage them to get in the health care field in some way. It's very important that you know that you want to interact with patients. You can't do that unless you are around them, and see them, interact with them – see how it's good to work with them, see how sometimes it's very difficult to work with them, but you have to like that, too. I would encourage them to shadow or volunteer."

"I'm very grateful I'm in this program, I'm excited that I'm in this program and for what's going to come out of it," said Seymour. "You can whine and complain about your school work and these tests as much as you want, but really what comes out of it is the main point. And the main point is that I'm competent to do this and I can help people and I'm excited about it. I guess I learned more about myself and the fact that you can go anywhere and get by without a toilet or without hot water or living with very minimal things – you can do it and still have the control to help others. You take for granted a lot the services we have here… I learned that you can go anywhere and still give effective care."

For more information about the Physician Assistant Studies program, visit www.mc.uky.edu/pa

In the News

Students and faculty from UK participated in a medical missions trip to Ecuador – on the way, their bus was caught in traffic after a tanker truck and bus collided. The 40+ members of the team rushed in to help the Ecuadorean medical response units.Click here to read the Herald-Leader's story

Jessica Seymour, a Physician Assistant Student in the University of Kentucky College of Health Sciences, poses with local children on her first day of clinics at a school in Cayambe, Ecuador.

A tanker truck and bus collided on a shoulder-less and narrow road, sending the bus careening down the ravine. Members of the UK Shoulder to Shoulder Ecuador team were stuck in traffic near in the accident site and rushed down to assist in the rescue effort.

Seymour conducts a physical exam on a woman in the clinic in Santo Domingo. The woman was very appreciative of Seymour's services and asked her to stay and be her doctor.

A young boy is "being strong" and posing for the camera while Jessica Seymour gives a physical exam in the Santo Domingo clinic.

Seymour with two young sisters at the Santo Domingo clinic in Ecuador.

Seymour, with the assistance of a translator (left) sees a mother and her four children at a clinic in the Tsachilla community. Most patients in the clinic came in large groups and were seeking routine check ups. Members of the UK Shoulder to Shoulder Ecuador team had to conduct their clinics using a picnic table – they were without an examination table and had little to no privacy.

Seymour holds a 4-year-old boy who she diagnosed and treated for pneumonia. Seymour heard crackles in his lungs during an examination and received confirmation of her assessment by Dr. Young, one of the leaders of the UK Shoulder to Shoulder Ecuador team. "It was at this point I realized I really was making a significant impact on these patients lives and if we were not there the outcome could be much worse," said Seymour.